Due to the cur­rent COVID-19 pan­dem­ic and the in­struc­tions to stay at home, many gym-go­ers and fit­ness fa­nat­ics are find­ing ways to en­sure that they re­main en­gaged in some form of phys­i­cal ac­tiv­i­ty or the oth­er.

Even the usu­al­ly seden­tary folks are join­ing in, fol­low­ing the many op­tions avail­able es­pe­cial­ly on so­cial me­dia. Face­book and In­sta­gram in par­tic­u­lar, are cur­rent­ly flood­ed with work­out videos, in­vi­ta­tions to join group ses­sions, and of­fers for per­son­al train­ing.

It is fair­ly safe to say thou­sands of peo­ple are en­gag­ing in var­i­ous forms and cat­e­gories of ex­er­cise and fit­ness which in­clude run­ning, HI­IT (high in­ten­si­ty in­ter­val train­ing), Taba­ta, yo­ga, cir­cuits, dance, gym­nas­tics and even con­tact sports like box­ing and kick­box­ing.

Af­ter all, there are con­stant re­minders to keep fit to sup­port your im­mune sys­tem and to stay healthy both men­tal­ly and phys­i­cal­ly. How­ev­er, there does not seem to be much dis­cus­sion on in­juries, or rather the treat­ment of in­juries, dur­ing these chal­leng­ing times, where­by one may not have easy ac­cess to a doc­tor or phys­io­ther­a­pist or such.

Most peo­ple are ac­cus­tomed to RICE (Rest, Ice, Com­pres­sion, El­e­va­tion), and it is a method that has been com­mon­ly used by both ath­letes and the av­er­age joe "work­ing out".

The RICE pro­to­col was in­vent­ed and coined by Dr Gabe Mirkin and pub­lished in 1978 in the best-sell­ing Sports Med­i­cine Book. It would, there­fore, be a sur­prise to many, that the same Doc­tor who in­vent­ed and coined the RICE pro­to­col, has since re­tract­ed his state­ments. Dr Mirkin is said to have in­di­cat­ed that the use of ice on in­juries may de­lay heal­ing in­stead, in the book, "Iced! The Il­lu­sion­ary Treat­ment Op­tion", Sec­ond Edi­tion, by Gary Reinl, 2014.

In an ar­ti­cle on his web­site, www.dr­mirkin.com, "Why Ice De­lays Re­cov­ery", Dr Mirkin al­so states: "Coach­es have used my "RICE" guide­line for decades, but now it ap­pears that both ice and com­plete rest may de­lay heal­ing, in­stead of help­ing".

He based his state­ments on a study of 22 sci­en­tif­ic ar­ti­cles (The Amer­i­can Jour­nal of Sports Med­i­cine, Jan­u­ary 2004) that did not find any sol­id ev­i­dence that the use of ice ac­cel­er­at­ed the heal­ing process of in­juries. Dr Mirkin fur­ther cit­ed a study in The Amer­i­can Jour­nal of Sports Med­i­cine, (June 2013) that while cool­ing de­layed swelling, it did not speed up the re­cov­ery of dam­aged mus­cles. The ar­gu­ment pre­sent­ed is that ic­ing pre­vents in­flam­ma­tion. How­ev­er, in­flam­ma­tion is the first step in the heal­ing process of tis­sue and mus­cle.

De­spite the above, oth­er stud­ies and ar­ti­cles have shown pos­i­tive re­sults in the use of ice, al­so known as cryother­a­py. The more re­cent pro­to­cols for treat­ment of in­juries are PRICE (Pro­tec­tion, Rest, Ice, Com­pres­sion, El­e­va­tion) and PO­LICE (Pro­tec­tion, Op­ti­mal Load­ing, Ice, Com­pres­sion, El­e­va­tion). The web­sites www.sports-health.com and www.physio-pe­dia.com both share the prin­ci­ples and tips on how to use ice with­in the treat­ment of in­juries.

Need­less to say, the ex­ist­ing stud­ies and re­search may give con­flict­ing in­for­ma­tion on ic­ing in­juries. How­ev­er, the ef­fect on pain is not dis­put­ed. The anal­gesic ef­fect of cryother­a­py, whether in the form of an ice pack, a pack of frozen peas or cold wa­ter im­mer­sion, has been proven in ba­si­cal­ly all doc­u­men­ta­tion. If for no oth­er rea­son, us­ing ice for an in­jury or mus­cle aches and sore­ness, can mean a sig­nif­i­cant­ly less painful ex­pe­ri­ence.

Still, we would like to look at pos­si­ble ways and rec­om­mend­ed meth­ods to treat mi­nor in­juries, aches and pains ob­tained from ex­er­cis­ing (es­pe­cial­ly nowa­days while at home).

The PO­LICE pro­to­col is easy to un­der­stand and fol­low.

Pro­tect: Aim - To pro­tect the in­jured tis­sue from un­due stress that may dis­rupt the heal­ing process; How - This could in­clude splint­ing or ban­dag­ing, mak­ing a sling, or us­ing crutch­es. Make sure the method of pro­tec­tion can ac­com­mo­date swelling; When and du­ra­tion - Im­me­di­ate­ly and for 3-5 days de­pend­ing on in­jury sever­i­ty.

Op­ti­mal Load­ing: Aim - To stim­u­late tis­sue heal­ing since too much rest can slow down re­cov­ery; How - Start sim­ple ex­er­cis­es gen­tly and care­ful­ly, then pro­gres­sive­ly work up to nor­mal lev­els of strength and move­ment; When and du­ra­tion - Rest for at least 24 hours af­ter in­jury, then be­gin a pro­gres­sive load­ing pro­gram un­til need­ed.

Ice: Aim - Ice helps con­strict the blood ves­sels there­by lim­it­ing bleed­ing, swelling and re­duces pain; How - Crushed ice wrapped in a damp tow­el or cloth is best; ice packs; or even a frozen pack of peas. Be sure that a cloth or tow­el is placed be­tween the skin and ice; When and du­ra­tion - The soon­er the bet­ter. Rec­om­mend­ed for 10-15 min­utes, every 3-4 hours, for up to 72 hours. (Be care­ful to re­frain from over-ic­ing).

Com­pres­sion: Aim - To re­duce and min­i­mize swelling; How - An elas­ti­cat­ed ban­dage can work. Wrap over­lap­ping each lay­er by half. Do not wrap too tight­ly!; When and du­ra­tion- As soon as pos­si­ble fol­low­ing in­jury and con­tin­ue for the first 72 hours to one week.

El­e­va­tion: Aim - To low­er the blood pres­sure to pre­vent swelling. Al­so to fa­cil­i­tate drainage of flu­id through the lym­phat­ic sys­tem. En­sure that the low­er limb is above the lev­el of the pelvis; How - Us­ing pil­lows, foot­stools, slings, etc; When and du­ra­tion - As soon as pos­si­ble fol­low­ing in­jury and at least for the first 72 hours.

PO­LICE pro­to­col adapt­ed from "Acute Soft Tis­sue In­jury Man­age­ment Up­date", writ­ten by Dr Chris Bleak­ley, phys­io­ther­a­pist, and lec­tur­er. He wrote the ar­ti­cle based on a doc­u­ment pub­lished by Phys­ios in Sport - As­so­ci­a­tion of Char­tered Phys­io­ther­a­pists in Sports and Ex­er­cise Med­i­cine (ACPSEM) in SportEX Med­i­cine, 2013, in which the PO­LICE pro­to­col was high­light­ed and high­ly rec­om­mend­ed.

Af­ter the first 72 hours, a slow tran­si­tion can be made to­wards us­ing heat. Heat in­creas­es and stim­u­lates blood flow, helps to re­lax mus­cles and pro­vides some re­lief to aching joints.

The rec­om­men­da­tions are not "one size fits all" and may need to be ad­just­ed ac­cord­ing­ly. Al­so, the very first step in case of an in­jury would be to speak with a doc­tor be­fore at­tempt­ing self-care.